| NPI | 1588891808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: DC PT871572) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004647) |
| 225100000X Physical Therapist (Licence: TX 1205472) | |
| 225100000X Physical Therapist (Licence: IN 05009889A) | |
| 225100000X Physical Therapist (Licence: FL 27116) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2014-03-07 |